Abstracts

Prognostic Factors Analysis for the Total Corpus Callosum Incision Surgery - Based on 9 Children with Drug-resistant Epilepsy

Abstract number : 2.444
Submission category : 9. Surgery / 9B. Pediatrics
Year : 2024
Submission ID : 1144
Source : www.aesnet.org
Presentation date : 12/8/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Shuhua Chen, MD, PhD – Beijing Children's Hospital, Capital Medical University, National Center for Children's Health

Yunlin Li, MD – Children's Hospital,Capital Institute of Pediatrics
Qian Chen, MD, PhD – Children's Hospital,Capital Institute of Pediatrics
Bojing Tan, MD – Children's Hospital,Capital Institute of Pediatrics
Guangbiao Qin, MD – Children's Hospital,Capital Institute of Pediatrics
Yingying Mao, MD – Children's Hospital,Capital Institute of Pediatrics

Rationale: To explore the prognostic factors of total corpus callosum incision surgery.

Methods: All patients included were children with drug-resistant epilepsy and underwent total corpus callosum incision surgery in our hospital from September 2016 to December 2019. All patients were operated after comprehensive preoperative evaluation and followed up for 1 year or more. VEEG examination should be conducted at least 4 hours or more after six months or more after corpus callosum incision. Determine the postoperative efficacy and prognosis based on the presence and frequency of seizures after surgery. Analyze the scalp video EEG characteristics before operation and the last follow-up, which includes background activity, intermittent epileptic discharges, seizure semiology, ictal EEG. Fisher's exact test were used (P ≤ 0.05).

Results: 9 patients were included(male: female=6:3), with an average age of 8.44 years (4-16 y/o) and the average follow-up time was 24.67 months (12-50 months). The results showed that (1)MRI showed significant structural lesions in 8/9 cases. Seizure recurred in 5/9 cases with lesions located in or involving the insula at not more than six months after surgery; However, seizure free was seen in three cases with structural changes not involving the insula and one case without obvious abnormalities. (2)All patients have multiple seizure types before surgery, including aura, dialeptic, simple motor seizures including atonic. tonic and/or spasms seizures are the most common (8/9). Among the 5 patients with definite atonic, atonic seizures disappeared almost right after surgery. Three patients with simple motor seizures had postoperative seizure signs limited to one side. Three patients with dialeptic seizures persisted after surgery. (3)PDR slowing and/or slow waves were shown in all 9 patients during pre-operation and post-surgery, the background in 3 patients back to normal, but there was no obvious relationship with surgical prognosis (P >0.05). all 9 patients had diffuse and more than 2 focus of interictal epileptic discharges pre-operation. But at the last follow-up, multiple focus epileptic discharges were shown in 5 children with persisted seizures or relapsed seizures, with 3/5 showed secondary synchronous discharges in both hemispheres; Among 4 patients with seizure free after surgery, epileptiform discharges disappeared in 2 cases, and only asynchronous discharges in the bi-occipital regions in 2 cases. Before surgery, the ictal EEG onset were all generalized in all types of seizures. Among the 5 patients with persisted seizures or relapsed seizures after surgery, the ictal EEG onset was diffuse in 4/5 of the cases, but one side seemed to be more obvious.

Conclusions: (1) Structural lesions displayed on MRI mainly located in or involving the insula have poor surgical prognosis, and caution should be taken in the patients to be CC; (2) The total section incision of the corpus callosum has a significant effect on atonic seizures; (3) The total corpus callosum incision surgery has a significant impact on the semiology and the ictal EEG onset which spread through the corpus callosum (secondary synchronization), and may result in focalization after surgery.

Funding: None

Surgery